Utilize Existing Facilities to Increase Efficiency

July 2, 2014 | Kristyna Culp

Every emergency department is interested in improving efficiency — but not every one can afford to renovate. Fortunately, there are a variety of strategies an ED can adopt to increase efficiency using their existing facilities. In fact, many of our clients hire us to help choose the strategies that make the most sense for a particular ED. Often, we often start by finding low-hanging fruit — opportunities for optimization that are relatively easy to identify and implement.

One of anything is a bottleneck

We’ve all experienced the frustrating backup and delay that happens when we’re in a hurry and there’s just one cashier in the store. The same can happen in an ED, when there’s just one check-in person, triage nurse, phlebotomist, or respiratory therapist and multiple patients needing treatment. The same problem also applies to inanimate objects: a single patient chart or EKG machine, for example.

Sometimes you have to make do with what you have. So what do you do when one is all you have, at least for the foreseeable future?

Be aware that one of anything is a bottleneck, and therefore expect patient queues. Go ahead and create space to accommodate the queues — literally.

Once you’re aware of the bottleneck, make the related step or steps as efficient as possible. Shaving off even 1% of the time required for a specific step adds up over the course of the day. For example, an immediate bedding model in an ED streamlines the intake process and allows the medical provider to initiate care sooner, improving medical outcomes and reducing patient length of stay. You could also spread the process out over other staff — or decrease the number of people going through the step, such as by requiring security screening only for patients and family going to the treatment areas.

If you have the option to add capacity, even for a limited amount of time, set a metric that helps you know when to implement the additional capacity. Cross-training staff may help; for instance, if there are more than three people in the intake queue, move departmental staff (Charge Nurse, Flow Coordinator, Float Nurse) to intake to manage the load. Once the queue is reduced, the extra staff go back to their original positions.

Even better, determine whether the step is necessary at all. Try to improve the processes surrounding the bottleneck with the goal of completely removing it entirely. Maybe you don’t need the step at all.

Be smart about how much space you need

Counterintuitive as it may seem, sometimes departments have too much treatment space to provide care efficiently. People and processes have a tendency to slow down, the more space they have to operate in.

Think of the high school student who has two months to work on an assignment but doesn’t really feel the urgency until the last two days. A similar effect can happen when an ED has too much treatment space. There’s a temptation to add beds, but by doing so the staffing model may not work as efficiently. More importantly, the waiting area may be emptied out, but within the treatment area, the sense of urgency is decreased, and care slows down.

One approach to counteract this dynamic is to prevent the natural tendency people have to expand into available space. For example, we have clients in Florida whose patient load is very seasonal: in the winter, they have 30 to 40% more patients than in the summer, due to the presence of “snowbird” seasonal residents. Fortunately, they have an entire area they can open up in the winter, which they keep closed in summer. It’s somewhat adjacent to the department, but across a hall, so when they need it, they have to staff it separately.

Question everything

Change is one of the most difficult things to face — both for individuals and organizations — and emergency departments are no different. With the pace and level of stress facing ED staff day in and day out, finding the time to stop and challenge assumptions can be extremely difficult, never mind the effort it takes to change a tried-and-true process. But the good news is that it can be done.

ABOUT THE AUTHOR Kristyna Culp MBAKristyna creates workflow mapping and computer simulation model frameworks to validate, test, and quantify various scenarios to help clients make informed decisions about both operational and physical design improvements. Read more from Kristyna.